Transphysäre Fixation bei Epiphyseolysis capitis femoris: Hinweise für femoroazetabuläres Impingement im Langzeitverlauf

Cr, Fraitzl; Nelitz, Manfred; Cakir, Balkan; Käfer, Wolfram; Reichel, Heiko

doi:10.1055/s-2008-1039223

Cited by 6 publications

(2 citation statements)

References 32 publications

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“…During the healing process, this leads to an anterolateral prominence (''bump'') on the proximal femur which can abut against or erode the acetabulum, leading to pain and decreased hip range of motion (hallmarks of FAI). Although common in severe slips, this can be seen in mild slips as well [20][21][22]. In addition, posteromedial callus formation, as a part of the chronic reactive healing process of SCFE, places tension on the posterosuperior retinaculum, which contains the blood supply to the femoral head, complicating potential corrective surgical options [12,13,22].…”

Section: Bony Impingement-pathologymentioning

confidence: 99%

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Hosalkar

Pandya

Bomar

et al. 2012

Journal of Children's Orthopaedics

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Background Femoroacetabular impingement (FAI) as a result of slipped capital femoral epiphysis (SCFE) has recently gained significant attention. Seen as an intermediate step toward the development of early osteoarthritis, symptomatic FAI develops in SCFE patients who have residual hip deformity characterized by relative posterior and medial displacement of the capital femoral epiphysis, leading to an anterolateral prominence of the metaphysis which abuts on the acetabular rim. This results in a decreased range of hip motion as well as progressive labral damage and articular cartilage injury, which cause symptoms of FAI. All degrees of slips from mild to severe can develop impingement. Methods The existing literature on the subject was thoroughly reviewed and all levels of studies that have made any meaningful changes to clinical practice were considered. Results Based on the literature review, current practice trends, and our own institutional practice pattern, all treatment options for SCFE in the impingement era have been presented with an open discussion regarding potential benefits and limitations. Conclusions Several surgical options exist for the SCFE patient who develops FAI. These are largely determined by the degree of deformity present and severity of the initial slip. Extraarticular (intertrochanteric, base of the neck) as well as subcapital osteotomies can be utilized with a goal of restoring proximal femoral anatomy in order to minimize the effect of the anterolateral prominence in more severe deformities. Patients with milder deformities can undergo osteochondroplasty of the femoral head and neck to remove impinging structures via either an open or arthroscopic approach. Also, proximal femoral osteotomy and open head-neck recontouring can be combined. Finally, patients who develop pain very early after in situ pinning must also be examined for potential iatrogenic screw-head impingement as a source of their pain and decreased hip motion, in addition to abnormalities in the proximal femoral anatomy. There are many centers that are approaching acute unstable SCFE patients as well as the more displaced stable cases with open reduction techniques that seem to be demonstrating good mid-term results. The goal of treatment is to improve patient function, alleviate hip pain, and to delay or prevent the development of early degenerative changes in adolescents and young adults. Prospective multi-center studies will be necessary so as to determine what methods work best in treatment and delay the onset and progression of osteoarthritis. Level of evidence V.

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Section: Bony Impingement-pathologymentioning

confidence: 99%

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Hosalkar

Pandya

Bomar

et al. 2012

Journal of Children's Orthopaedics

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“…Due to the hinge and lever effect on the acetabulum rim, increasing stress on the posterior acetabular cartilage is applied as well as direct antero-superior labral injuries [ 4 ]. Early degenerative changes with cartilaginous and labral injuries have been reported not only in moderate and severe but also in mild SCFE [ 3 , 5 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic osteochondroplasty in patients with mild slipped capital femoral epiphysis after in situ fixation

Tscholl

Zingg

Dora

et al. 2016

Journal of Children's Orthopaedics

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PurposeMild slipped capital femoral epiphyses (SCFE) nevertheless show significant femoral head–neck deformities which may put cartilage and acetabular labrum at risk. Whether this deformity can be restored to normal has not yet been described in the literature.MethodsIn a prospective follow-up study, 14 patients with mild SCFE underwent in situ fixation with a single 6.5-mm cancellous, partially threaded screw. In 14 patients arthroscopic osteochondroplasty was performed, and in 13 patients pre- and postoperative measurements of the α-angle were made using antero-superior radial magnetic resonance imaging.ResultsAfter arthroscopic osteochondroplasty, the mean α-angle decreased from 57° (range 50°–74°) to 37° (range 32°–47°; p < 0.001). Six patients showed beginning degenerative intra-articular changes (four antero-superior cartilage and three antero-superior labrum lesions) at the time of hip arthroscopy. No intra-operative complications occurred. In one patient, arthroscopic debridement was necessary due to arthrofibrosis and persistent pain.ConclusionArthroscopic osteochondroplasty can successfully correct the antero-superior α-angle in patients with mild SCFE to normal values. Clinical randomized controlled studies with long-term follow-up are required to find evidence of improved functional and radiographic mid- and long-term outcome compared to in situ fixation alone.

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Current concepts in the diagnosis and management of femoroacetabular impingement

Imam

Khanduja

2011

International Orthopaedics (SICOT)

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Femoroacetabular impingement is becoming increasingly recognised as a cause of hip pain in the young adult. It is thought that the condition may lead to acetabular labral tears, chondro-labral separation, chondral delamination and eventually predispose to osteoarthritis of the hip. Efforts have thus been directed to diagnosing and treating the underlying pathology and subsequent sequelae. This article presents the relevant literature with regards to the aetiology of femoroacetabular impingement, its clinical features, investigations and options of management. Finally outcomes relating to both open and arthroscopic approaches to treatment are discussed.

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Transphysäre Fixation bei Epiphyseolysis capitis femoris: Hinweise für femoroazetabuläres Impingement im Langzeitverlauf

Abstract: Clinical evaluation of 20 patients at a mean of 14.9 years after transfixation of the epiphysis revealed some evidence for the presence of FAI in affected hip joints. Radiological evaluation suggests that its localisation is more lateral and less anterior.

Cited by 6 publications

References 32 publications

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Hip impingement in slipped capital femoral epiphysis: A changing perspective

Arthroscopic osteochondroplasty in patients with mild slipped capital femoral epiphysis after in situ fixation

Current concepts in the diagnosis and management of femoroacetabular impingement

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